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Get ready for your doctor visit

Preparing for your appointment helps guarantee you_ll get the most from every minute of that one-on-one time with your doctor. Fill this out before your appointment and take it with you.

Provided by HealthMonitor

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1 Changes to my medications, including prescription and over-the-counter drugs and supplements, since my last appointment include:
'''''''''''''''''''''''''''''''''

2 Since my last visit, I've noticed these symptoms (write down the symptom, when it struck and what, if anything, brought relief):
Symptom "''''''''''''''''''''''''
Words that describe it: "'''''''''''''
Rate pain on a scale from 0 to 10: "''''
When it strikes "'''''''''''''''''''
What brings relief "'''''''''''''''''

Symptom "''''''''''''''''''''''''
Words that describe it: "'''''''''''''
Rate pain on a scale from 0 to 10: "''''
When it strikes "'''''''''''''''''''
What brings relief "'''''''''''''''''

Symptom "''''''''''''''''''''''''
Words that describe it: "'''''''''''''
Rate pain on a scale from 0 to 10: "''''
When it strikes "'''''''''''''''''''
What brings relief "'''''''''''''''''

3 I'd like to discuss the following concerns. Can you help me address them in the best order?
1. "'''''''''''''''''''''''''
2. "'''''''''''''''''''''''''
3. "'''''''''''''''''''''''''

4 I have had the following lab tests or procedures since my last visit:
1. Test/procedure "'''''''''''''
Result "''''''''''''''''''''''
2. Test/procedure "'''''''''''''
Result "''''''''''''''''''''''
3. Test/procedure "''''''''''''''
Result "'''''''''''''''''''''

First visit?
Be prepared to supply:
o Your health insurance information
o Your medical history
o Your family health history
o Contact information for all your healthcare providers
o'Liver ultrasound or imaging reports
Ultrasound Pain

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